Two Point Discrimination
| Status: | Recruiting |
|---|---|
| Conditions: | Back Pain, Back Pain, Chronic Pain, Fibromyalgia, Other Indications, Orthopedic, Psychiatric, Pain |
| Therapuetic Areas: | Musculoskeletal, Psychiatry / Psychology, Rheumatology, Orthopedics / Podiatry, Other |
| Healthy: | No |
| Age Range: | 10 - 17 |
| Updated: | 9/29/2018 |
| Start Date: | July 21, 2018 |
| End Date: | July 16, 2023 |
| Contact: | Geraldine C Schulze |
| Email: | geraldine.schulze@cchmc.org |
| Phone: | 513-978-3007 |
Retuning the Nervous System in Youth With Chronic Pain
SPECIFIC AIMS
Pain in both youth and adults is a complex, subjective and personal experience, and remains
poorly understood. One particularly perplexing dimension of some forms of pain is the
tendency of pain to spread outside of an affected body site to adjacent location, and then to
unaffected body sites. Such widespread pain may reflect an altered spatial tuning of
somatosensory processing, such that lateral inhibition is diminished, thereby allowing pain
to spread. To date, no therapies exist which are designed specifically to diminish or even
reverse the spatial spread of pain. However, training in two-point discrimination holds the
potential to retune spatial aspects of somatosensory processing and may represent a novel
therapy for widespread pain. Thus, the present investigation will test the following aims:
Aim 1. Do youth with chronic pain have disrupted spatial tuning of somatosensory processing?
Deficits in two point tactile discrimination have long been noted in adults with chronic
pain, but such deficits remain poorly documented in pediatric chronic pain patients. In order
to determine if such deficits exist, youth with both chronic pain and healthy youth will
undergo assessment of two point discrimination thresholds.
Aim 2. Does two-point discrimination training result in diminished pain and disability in
youth with somatic pain? After initial characterization of tactile discrimination thresholds,
youth with chronic pain will participate in multiple sessions of either two-point
discrimination training or a single-point spatially-directed attentional control condition.
Training will involve up to 9 additional sessions. Efficacy of training will be assessed by
1) reductions in the spatial extent of pain, 2) reductions in pain intensity and
unpleasantness, and 3) reductions in pain-related disability.
Pain in both youth and adults is a complex, subjective and personal experience, and remains
poorly understood. One particularly perplexing dimension of some forms of pain is the
tendency of pain to spread outside of an affected body site to adjacent location, and then to
unaffected body sites. Such widespread pain may reflect an altered spatial tuning of
somatosensory processing, such that lateral inhibition is diminished, thereby allowing pain
to spread. To date, no therapies exist which are designed specifically to diminish or even
reverse the spatial spread of pain. However, training in two-point discrimination holds the
potential to retune spatial aspects of somatosensory processing and may represent a novel
therapy for widespread pain. Thus, the present investigation will test the following aims:
Aim 1. Do youth with chronic pain have disrupted spatial tuning of somatosensory processing?
Deficits in two point tactile discrimination have long been noted in adults with chronic
pain, but such deficits remain poorly documented in pediatric chronic pain patients. In order
to determine if such deficits exist, youth with both chronic pain and healthy youth will
undergo assessment of two point discrimination thresholds.
Aim 2. Does two-point discrimination training result in diminished pain and disability in
youth with somatic pain? After initial characterization of tactile discrimination thresholds,
youth with chronic pain will participate in multiple sessions of either two-point
discrimination training or a single-point spatially-directed attentional control condition.
Training will involve up to 9 additional sessions. Efficacy of training will be assessed by
1) reductions in the spatial extent of pain, 2) reductions in pain intensity and
unpleasantness, and 3) reductions in pain-related disability.
STUDY DESIGN Prior to commencing this investigation, investigators will optimize the tactile
discrimination threshold testing (i.e. as per baseline visit, below), and the training
conditions, in up to ten participants (patients and/or healthy controls). This will serve as
a pilot to refine operational aspects of study procedures before investigators commence the
main investigation proposed herein. Following this, youth with either chronic pain (ages
10-17, n=40) or healthy youth (ages 10-17, n=20) will undergo assessments of two-point and
single-point discrimination thresholds in an initial session (Aim 1). After this initial
session, youth with chronic pain will participate in up to 9 additional sessions of
attentional training (Aim 2). These chronic pain patients will be randomized to either
two-point discrimination training (n=20) or a single-point spatially-directed attentional
control condition (n=20). Participants will not be informed of which intervention they will
receive (single-blind study). Psychological questionnaires will be completed in the first and
last sessions in order to determine how these variables relate to tactile discrimination and
response to training.
STUDY INTERVENTIONS 5.1 Two Point Discrimination Training: Two-point discrimination threshold
(TPD) training may be performed 1) at spatial locations remote from pain, 2) at spatial
locations adjacent to the region of pain, and/or 3) at spatial locations in the site of pain,
if the participant will tolerate it. TPD is defined as the smallest distance between two
points at which someone can recognize two points, and not one, touching their skin. As such
this is a test of one's ability to identify separate stimulation of two discrete areas, and
relies heavily on lateral inhibition. Highly precise mechanical calipers will be gently
placed onto the skin and the distance between the prongs will be increased/decreased. After
repeated decreases and increases in the distance between the prongs, the TPD will be deemed
as the distance at which participants consistently report two points instead of one.
One-point stimuli will be interleaved to serve as a control condition. Participants will be
informed immediately of correct and incorrect responses as part of the discrimination
training.
5.2 Control Stimulation: Participants will undergo a single-point discrimination training at
the same sites as described above. Probes of different sizes will be used for this portion -
a small diameter probe (~1-5 mm) and a large diameter probe (~6-50mm). The probes will be
gently placed in contact with the participants' skin, and the participant will be instructed
to respond if they were contacted with the small or large probe. Participants will be
informed immediately of correct and incorrect responses as part of the discrimination
training.
discrimination threshold testing (i.e. as per baseline visit, below), and the training
conditions, in up to ten participants (patients and/or healthy controls). This will serve as
a pilot to refine operational aspects of study procedures before investigators commence the
main investigation proposed herein. Following this, youth with either chronic pain (ages
10-17, n=40) or healthy youth (ages 10-17, n=20) will undergo assessments of two-point and
single-point discrimination thresholds in an initial session (Aim 1). After this initial
session, youth with chronic pain will participate in up to 9 additional sessions of
attentional training (Aim 2). These chronic pain patients will be randomized to either
two-point discrimination training (n=20) or a single-point spatially-directed attentional
control condition (n=20). Participants will not be informed of which intervention they will
receive (single-blind study). Psychological questionnaires will be completed in the first and
last sessions in order to determine how these variables relate to tactile discrimination and
response to training.
STUDY INTERVENTIONS 5.1 Two Point Discrimination Training: Two-point discrimination threshold
(TPD) training may be performed 1) at spatial locations remote from pain, 2) at spatial
locations adjacent to the region of pain, and/or 3) at spatial locations in the site of pain,
if the participant will tolerate it. TPD is defined as the smallest distance between two
points at which someone can recognize two points, and not one, touching their skin. As such
this is a test of one's ability to identify separate stimulation of two discrete areas, and
relies heavily on lateral inhibition. Highly precise mechanical calipers will be gently
placed onto the skin and the distance between the prongs will be increased/decreased. After
repeated decreases and increases in the distance between the prongs, the TPD will be deemed
as the distance at which participants consistently report two points instead of one.
One-point stimuli will be interleaved to serve as a control condition. Participants will be
informed immediately of correct and incorrect responses as part of the discrimination
training.
5.2 Control Stimulation: Participants will undergo a single-point discrimination training at
the same sites as described above. Probes of different sizes will be used for this portion -
a small diameter probe (~1-5 mm) and a large diameter probe (~6-50mm). The probes will be
gently placed in contact with the participants' skin, and the participant will be instructed
to respond if they were contacted with the small or large probe. Participants will be
informed immediately of correct and incorrect responses as part of the discrimination
training.
Inclusion Criteria:
Chronic Pain Patients:
- Somatically located chronic pain
- amplified musculoskeletal pain syndrome
- complex regional pain syndrome
- low back pain
- fibromyalgia
- other forms of chronic, widespread pain
- Male or female, 10-17 years
- High fluency in written and oral English language
Control Participants:
- Youth in good general health
- Male or female, 10-17 years
- High fluency in written and oral English language
Exclusion Criteria:
- Present significant mental health disorder as defined by DSM V (e.g. psychosis,
bipolar disorder, major depression),
- alcohol or drug dependence
- documented developmental delays or impairments (e.g., autism, cerebral palsy, or
mental retardation) of a magnitude that would interfere with adherence to study
requirements or safe participation in the study
- Primary complaint of migraine or visceral (abdominal) pain, with minimal somatic
involvement.
We found this trial at
1
site
3333 Burnet Avenue # Mlc3008
Cincinnati, Ohio 45229
Cincinnati, Ohio 45229
1-513-636-4200
Principal Investigator: Robert C Coghill, PHD
Phone: 513-517-0593
Cincinnati Children's Hospital Medical Center Patients and families from across the region and around the...
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